Louisville High School 1201 S

LAKE HIGH SCHOOL 1025 LAKE CENTER STREET NW UNIONTOWN, OHIO 44685 (330) 877-4282

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OUT OF SCHOOL GUEST APPLICATION

Lake High School Function JUNIOR-SENIOR PROM Location The McKinley Grand

Date/Time Saturday, May 5,2018 5:45 p.m. – 10:00 p.m.

Lake students wishing to bring one non-Lake student guest to the above Lake High School function must receive approval from the Lake High School administration. This completed form must be submitted to the high school administration and approved before purchasing tickets to this function.

All Lake High School rules will be in effect at this function and are applicable to both our student and the guest. After entering the building, no one will be permitted to leave the building and return to the dance.

** Please note that no middle school students, 9th graders, or persons over twenty (20) years of age will be permitted at this function.

------LAKE STUDENT INFORMATION

Name ______Age _____ Grade _____ Phone # ______

Parent/Guardian Name(s) ______

I understand that I am subject to Lake High School disciplinary action based on the behavior and actions of myself and the actions of my non-Lake High School student guest.

Student Signature ______Date ______

Parent/Guardian Signature ______Date ______

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NON-LAKE HIGH SCHOOL STUDENT INFORMATION/RESPONSIBILITY STATEMENT

Name ______Grade ______Age ______

Address ______Home Phone # ______

Parent/Guardian Name(s) ______

High School/College Attending ______

High School Attended ______Year of Graduation ______

High School Telephone Number ______

I understand that I am subject to all Lake High School rules and responsibilities. I furthermore understand that my Lake High School escort is equally subject to disciplinary actions based on my behavior and actions.

Guest Signature ______Date______

My son/daughter has my permission to participate in the function listed above. I understand that I am ultimately responsible for his/her actions and behaviors. I permit Lake High School and Lake Local School staff and administration to take any actions necessary to maintain orderly conduct at this function.

Parent/Guardian of Guest Signature ______Date ______

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AFFIRMATION STATEMENT FROM PRINCIPAL OF GUEST STUDENT

By affixing my signature and school seal, I hereby attest that the student applying for out-of-school guest approval has maintained acceptable standards of behavior, attendance, and academic performance.

Principal’s Signature______Date ______

** PLEASE NOTE: Violations of Lake dress code or any inappropriate dancing or behavior will result in immediate removal from the premises and possible future disciplinary action.